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34 Cards in this Set
- Front
- Back
What is Dysrhythmias?
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Electrical conduction abnormalities of the heart.
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What are the 3 classes of drugs used in the treatment of Dysrhythmias?
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A. Sodium channel Blockers: quinidine (Quinidex)
B. Beta-adrenergic blockers: propranolol (Inderal) C. Calcium channel blockers: verapamil (Calan) |
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Main example of
Sodium channel Blockers |
quinidine (Quinidex)
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Main example of
Beta-adrenergic blockers |
propranolol (Inderal)
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Main example of
Calcium channel blockers |
verapamil (Calan)
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class of:
quinidine (Quinidex) |
Antiarrhythmic
Sodium channel Blockers |
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Mechanism of:
quinidine (Quinidex) |
- Blocks sodium ion channels in myocardial cells thereby:
i. reducing automaticity in ventricles ii. slowing conduction of action potential across myocardium. - Reduces the excitability of cardiac muscle to electrical stimulation. - Decreases the velocity of electrical conduction through the myocardium. - Decrease HR and reduce or obliterate ectopic pacemaker activity. - Exerts anticholinergic (vagal blocking) action on the heart. |
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usage of:
quinidine (Quinidex) |
Quinidine is use in the treatment of atrial & ventricular dysrhythmias (tachycardia, flutter and fibrillation).
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Side effects/Adverse reaction:
quinidine (Quinidex) |
diarrhea, nausea, vomiting, cardiac arrthythemias, cinchonism
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what drug may interact with quinidine (Quinidex)?
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Digoxin
-increased digoxin levels and toxicity- |
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What type of patient should use quinidine (Quinidex) with caution?
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- Clients with CHF
- Clients using digoxin. - Hypo or hyperkalemic clients. - Client with fluid or electrolyte imbalance. - Must administer a test dose. |
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what should patient taking quinidine (Quinidex) be observe for?
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- changes in EKG
(Increase in PR and QT intervals or widening of QRS complex) - BP - LOC - Respiratory status - Drug plasma levels |
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When Pt. is taking quinidine, what should Pt. education includes?
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- Do not skip doses
- Do not take two doses at one time - Comply with monitoring of lab tests as ordered. - Report these symptom immediately: SOB, changes in vision or hearing, diarrhea, or dizziness. |
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What symtom(s) should Pt taking quinidine report immediately?
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1. SOB
2. changes in vision or hearing 3. diarrhea 4. dizziness. |
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give an example of
Beta-Adrenergic Blockers |
propranolol (Inderal)
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Main use of
propranolol (Inderal) |
main use is to treat atrial dysrhythmias HF
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other uses of
propranolol (Inderal) |
Hypertension, MI, HF.
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MAO of
propranolol (Inderal) |
- Act by blocking Beta-adrenergic receptor thereby decreases sympathetic influences on the heart.
- Resulted in decreasing: 1. HR (negative chronotropic effect) 2. cardiac workload 3. contractillity 4. myocardial oxygen consumption. 5. conduction velocity through AV node 6. myocardial automaticity 7. release of renin = lower BP 8. vasocinstriction |
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Common Adverse Effects of
propranolol (Inderal) |
1. Hypotension
2. Hypoglycemia others: fatigue, gastric pain, flatulence, constipation, diarrhea, nausea, vomiting, bradycardia, CHF, cardiac arrhythmias, SA or AV block, impotent, decreased libido, decrease excercise intolerance. |
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Drugs that may interact with
propranolol (Inderal) |
1. Phenothiazines
2. Beta-adrenergic agonists (Albuterol) 3. MAO inhibitors |
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Contraindications for
propranolol (Inderal) |
clients with
1. obstructive pulmonary disease 2. CHF 3. heart block 4. bradycardia 5. DM. |
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What assessment should the nurse take prior to administration of
propranolol (Inderal)? |
1. PR and
2. cognitive status in elderly |
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what Special consideration for Pt. prior to administration of
propranolol (Inderal) |
Asians: due to the lack of drug metabolizing enzyme mephenytoin hydrizylase.
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what should Patient Education includes for propranolol (Inderal)?
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1. Take PR prior to drug administration (w/h if PR is <60 or >100)
2. Rise sitting or lying position slowly. 3. Signs of hypoglycemia in diabetes such as fatigue or headaches. 4. Report the following symptoms immediately: 1) SOB 2) Feeling of skipping heart beat 3) Painful or difficult urination 4) Dizziness, drowsiness, confusion |
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When taking propranolol, what symptoms should Pt. report immediately?
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1) SOB
2) Feeling of skipping heart beat 3) Painful or difficult urination 4) Dizziness, drowsiness, confusion |
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give example of
Calcium channel blockers |
verapamil (Calan)
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Drug classes of
verapamil (Calan) |
- Calcium channel-blocker
- Antianginal agent - Antiarrhythmic - Antihypertensive |
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MOA of
verapamil (Calan) |
Inhibits the movement of calcium ions across the membranes of cardiac and arterial muscle cells
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Desired actions of
verapamil (Calan) |
1. decreased cardiac workload
2. decrease oxygen demand 3. decreased cardiac energy consumption 4. increased delivery of oxygen to myocardial cells |
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indication of
verapamil (Calan) |
Supraventricular dysrhythmias
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Adverse effects of
verapamil (Calan) |
constipation
bradycardia |
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interactions with:
verapamil (Calan) |
1. Grapefruit juice
2. digoxin |
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Nursing implications for
verapamil (Calan) |
1) Take BP and report changes
2) Take pulse and notify if less than 60 bpm 3) Report irregular heart beat, shortness of breath, swelling of the hands or feet (edemas) |
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What symptom should Pt taking
verapamil (Calan) report immediately? |
1. irregular heart beat
2. shortness of breath 3. swelling of the hands or feet (edemas) |